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Year 3 Academic Weeks > A6- Sexual Dysfunction in the Male Patien > Flashcards

A6- Sexual Dysfunction in the Male Patien Flashcards

1
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A
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3
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4
Q

Physiology of the penis (erect)

A

You first need to have sexual desires intiated by testosterone. Once that signal is made, it is sent down throught the spinal cord. Once it gets to the pelvis, it comes around it and then moves to rectum and around the prostate and into the base of the penis. As penis start to erect you get trapping of the emissary veins and so the penis becomes rigid

(increases inflow) Arteries open up so that the blood starts to flow into the cavernous artery and as the blood starts to flow in, the lacuna spaces start to fill up.

As they fill up the emmissary veins are compressed. Then you start to get less outflow and you start to get less outflow, the penis starts to become erect.

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5
Q

List and briefly describe the major causes of erectile dysfunction

A
  • Vascular
  • Psychological
  • Endocrine: testosterone deficiency
  • Neurological: any problems with nerves like secondary to diabetes or spinal cord injury
  • Drugs
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6
Q

What is the hormone in males that give you the sexual desire

A

testosterone

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7
Q

What is a common vascular cause of erecticle dysfunction

and why does this occur?

A
  • Common aetiology with cardiovascular disease
  • Due to endothelial dysfunction and build up of cholesterol plaques
  • ED precedes MI by 5 years in non diabetic and 18 months in diabetic
  • Cardiovascular screening of all men with ED
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8
Q

Risk Factors for CVD

A
  • Diabetes
  • Smoking
  • Alcohol Use
  • High blood pressure
  • High cholesterol
  • Age
  • Obesity
  • Low Testosterone
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9
Q

Name some drugs that implicate erectile dysfunction?

A

• Diuretics

•Antihypertensives

  • Antihistamines
  • Antidepressants
  • Parkinson’s disease drugs
  • Antiarrhythmics
  • Tranquilizers
  • Muscle relaxants
  • Histamine H2-receptor antagonists

• Hormones.

  • Nonsteroidal anti-inflammatory drugs
  • Chemotherapy medications

•Prostate cancer drugs: reducing testosterone

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10
Q

What are some illicit drugs that cause erectile dysfunction?

A

•Alcohol

  • Amphetamines
  • Barbiturates

• Cocaine

  • Marijuana
  • Methadone

• Nicotine: vasocontriction

• Opiates

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11
Q

: List the important components of the history when interviewing a patient with ED

A
  • Onset
  • Situational
  • Morning / night time erections: if there is no morning and night erections then that fits with a physiological cause and no pyschological
  • Libido – sexual desire
  • Exclude premature ejaculation
  • Relationship issues
  • PMHx including medications, drug use and trauma
  • Risk factors for cardiovascular disease including FHx
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12
Q

In a ED history what are the difference you see in a psychogenic cause and organic

A
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13
Q

Outline the important components of the physical examination of a patient with ED

A
  • Height, weight, BMI, Waist circumference, BP
  • Secondary sexual characteristics including testis and penile development and abnormalities • Check lower limbs for pulses
  • Gross neurology including lower limb reflexes and anal tone
  • Assess the prostate if appropriate
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14
Q

List the treatment options for erectile dysfunction and describe the mechanisms by which they work

Lifestyle

Oral treatments

A

Lifestyle Modification: • Weight loss •Increase exercise •Stop smoking • Manage lipids, diabetes and cardiovascular risk factors

Oral Treatments: Phosphodiesterase inhibitors (PDE5i). •Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) • Not aphrodisiacs • Need sexual stimulation to work • Need to try multiple doses

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15
Q

What is alprostadil?

A

Prostaglandin E1

Can come in creams (inserted into urethra), MUSE, injectable forms

Used for erection

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16
Q

What is the mechanism of PDE5i/Alprostadil

A

Nerves coming in from LHS

(in red) PDE5 inhibitors stop the breakdown of cyclic GMP, two five GMP and that causes a decreased calcium and aterial smooth muscle relaxation. This is only in response to nerve stimulation. So PDE5 inhibitors need sexual stimulation

Looking at alprostadil the prostaglandin E1s, you can see that they are independent in action of nerve stimulation so they cause a rise in cyclic AMP which again causes calcium reduction and arterial smooth muscle relaxation, so alprostadil will cause erection

17
Q

How do vacuum devices cause erections

A

They pull blood into the penis creating a vacuunm around the penis

They can be used in combination with PDE5 inhibitors such as Slidenafil

18
Q

Describe the contra-indications and side-effects of phosphodiesterase inhibition for ED

A
  • Unfit for sexual activity
  • Hypotension or uncontrolled hypertension
  • Severe hepatic impairment
  • Retinitis pigmentosa
  • Drugs – nicorandil, nitrates (care with alpha blockers)
  • Care with drugs metabolised by cytochrome p450 and grapefruit juice
  • Cocaine
19
Q

PDE5i are used for which type of people

A

unfit people

20
Q

Side Effects of ED treatment

A
  • Facial flushing and headache
  • Nasal congestion
  • Dizziness due to low blood pressure
  • Indigestion •Back and leg pain (Tadalafil)
  • Visual disturbance (Sildenafil)
21
Q

•A 54 year old business man attends his GP complaining of a 12 month history of gradually worsening erectile dysfunction. He looks obese and has a cigarette packet in his top pocket. •

What is the most likely cause for his erectile dysfunction?

A

Vascular

22
Q

What is premature ejaculation?

A

•Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like.

Features include:

Always or nearly always ejaculate within one minute of penetration

Unable to delay ejaculation during intercourse all or nearly all of the time

Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

23
Q

Incidence of premature ejaculation

A
  • Premature ejaculation is a common sexual complaint
  • Estimates vary, but as many as 4 and 39% of men
24
Q

Classification of premature ejaculation

A

• Lifelong (primary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with first sexual encounters.

• Acquired (secondary). Acquired premature ejaculation develops after previous sexual experiences without ejaculatory problems

25
Q

premature ejaculation causes

A
  • Psychological – early sexual experiences, abuse, body image
  • Erectile dysfunction
  • Relationship problems
  • Biological causes – hormones, inflammation, hereditary
  • Some evidence that life long is related to central 5-HT receptor sensitivity
  • Some evidence that acquired is related to anxiety
26
Q

Tx for premature ejaculation

A
  • Combined approach •Psychosexual support – pelvic floor exercises / squeeze technique
  • Condoms / Topical anaesthetics – reduce sensation
  • Oral medications – drugs such as Dapoxetine that have the side effect of delaying ejaculation
  • If ED is a problem address that too
27
Q

What is Peyronie’s Disease?

A

is a noncancerous condition resulting from fibrous scar tissue that develops on the penis and causes curved, painful erections

plaque forming in the fascia layer

28
Q

How common is Peyronie’s Disease?

A
  • 3-9% of population
  • Most common in 5th decade
29
Q

Peyronie’s Disease? congential

A

• Congenital – with hypospadias •Young onset associated with raised HbA1c

30
Q

Diagnosis of Peyronie’s Disease? History

A
  • Classically starts with penile pain during erection
  • Followed by bend
  • May or not have palpable plaque
  • ED may also occur
  • Associated with: Dupuytren’s Contracture, Lederhosen’s Disease, DM, Hypertension, RARP
31
Q

Peyronie’s Disease DIagnosis? Examination?

A

•Plaque may be palpable on the side of the bend •Photos or induced erection • No routine investigations as it is a clinical diagnosis

32
Q

Management for Peyronie’s Disease?

A

•Explanation of the condition • 13% resolve of the remainder half stabilise and half progress • Natural history is over 12-24 months •Stretching – vacuum and traction devices • Medical – oral / topical / intralesional •ESWL – trial only •Surgery – plication / excision / prosthesis •BUT also maximise erectile function

33
Q

•A 27 year old man attends his GP because he and his wife have been trying to conceive for 12 months unsuccessfully despite not using contraception. On closer questioning the man reveals that during the majority of attempts at intercourse he ejaculates prior to penetration. •

What is the most likely diagnosis?

A

Peyronie’s Disease

Year 3 Academic Weeks (40 decks)

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